Project Materials

EFFECT OF A TRAINING PROGRAMME ON KNOWLEDGE AND PRACTICE OF LIFESTYLE MODIFICATION AMONG HYPERTENSIVE PATIENTS ATTENDING OUT-PATIENT CLINICS

CHAPTER ONE

INTRODUCTION

1.0 Background of the Study 

The world’s most prevalent non-communicable disease and the main contributor to cardiovascular disease is hypertension. Since many persons with hypertension are ignorant of their illness, treatment is infrequent and insufficient, which contributes to its poor management and lack of attention (Neutel & Campbell, 2008).

The majority of people with hypertension have essential hypertension, often known as type 1 hypertension. This kind of hypertension has been largely attributed to heredity and bad lifestyle choices.

The adoption of the western lifestyle, along with its problems of poverty, an unhealthy environment, a lack of health-seeking behaviour, a lack of health insurance, and a sedentary lifestyle, has made this a threat, particularly in Africa.

The specific guideline for treating hypertension, as stated in the Seven Joint National Committee Criteria (JNC7), is to start with lifestyle changes and finish with medication. Regretfully, a large number of people with hypertension diagnoses typically lack the necessary understanding about changing their lifestyle.

Weight loss, following the Dietary Approaches to Stop Hypertension (DASH) diet, exercising, and consuming less salt are healthy lifestyle choices that have been shown to lower blood pressure and its complications, particularly the rate of morbidity and mortality of cardiovascular diseases (Jafari, Shahriari, Sabouhi, Farsani & Babadi, 2016).

For all hypertension patients receiving pharmaceutical treatment, lifestyle change is recommended as it may eliminate or perhaps lessen the requirement for medication.

Lowering blood pressure is the aim of recommended lifestyle modifications. Numerous health advantages and improved results for common chronic diseases are also provided by these lifestyle modifications (Huang, Duggan & Harman, 2008).

However, research has shown that some of the obstacles to leading a healthy lifestyle and failing to avoid and control high blood pressure are ignorance, lack of understanding, and lack of awareness.

As evidenced by a study’s findings that “when the score of knowledge in high blood pressure patients increases by one, their score of practice would increase by 0.12,”

it is assumed that greater awareness of the role of lifestyle in the occurrence of high blood pressure would lead people to begin changing their lifestyles and improving their preventive behaviours. Shahriari, Babadi, Farsani, Sabouhi, and Jafari (2016).

Nevertheless, research has indicated that raising awareness and knowledge alone may not be sufficient to manage the consequences of illnesses; however, systolic and diastolic blood pressure would be considerably reduced by raising the attitude score towards high blood pressure through reinforcement.

Although there are many additional obstacles that can keep people from changing their lifestyle, research has shown that changing one’s perceptions, attitude, and level of knowledge can all encourage people to change their way of life (Jafari, Shahriari, Sabouhi, Farsani & Babadi, 2016).

The DASH diet, regular cardiovascular exercise, reducing dietary salt, moderate alcohol consumption, and weight loss of 3% to 9% of body weight are all suggested lifestyle changes that lower blood pressure.

Blood pressure reductions of 3 to 11 mm Hg systolic and 2.5 to 5.5 mm Hg diastolic are thought to have a significant impact on blood pressure reduction and the capacity to enhance antihypertensive medications, depending on the type of intervention.

The DASH diet, which is advised, is low in red meat, sugar, sugary drinks, refined carbs, and total and saturated fat but high in fruits, vegetables, whole grains, chicken, fish, and low-fat dairy products.

It has long been known that following the DASH diet reduces weight, heart rate, apolipoprotein B, homocysteine, C-reactive protein, and the risk of type 2 diabetes. It also lowers the incidence of heart failure, stroke, and all-cause mortality (Lochner, Rugge & Judkins, 2006).

According to a prime trial, a DASH diet combined with weight loss, aerobic exercise, alcohol and salt reduction, and weight loss results in a 14.2/7.4 mmHg drop in blood pressure.

Over a six-month period, the prevalence of hypertension is also reduced from 38% to 12%. Reducing salt intake in hypertension patients may be the most crucial hypotensive strategy.

This involves avoiding processed foods, employing spices and herbs for flavour, and routinely checking product labels for salt levels.

It is widely acknowledged that patients’ individual efforts combined with supportive and encouraging environments from medical professionals will result in significant success with food and behaviour changes (Nicoll & Henein 2010).

However, several studies have demonstrated that patients with high blood pressure do not fully understand and implement lifestyle adjustment. Many hypertension patients in the UK, according to Nicoll and Henein’s (2010) study, are unwilling to acknowledge that their lifestyle choices or practices have significantly contributed to their disease and may reject suggestions to change. This may also be the case for other hypertensive individuals.

Therefore, it is recommended that health education regarding hypertension, its effects, and lifestyle change start as soon as feasible in populations that have been identified as being at risk (American Heart Association, 2010).

1.1 Statement Of The Problem 

Although there are several medications and treatment guidelines for hypertension, it has never been possible to get people to lower their blood pressure.

Changing one’s lifestyle is one of the recommendations for treating hypertension. Among older adults worldwide, poorly regulated blood pressure is a significant public health concern in terms of economic burden, morbidity, and mortality.

The primary and most important modifiable risk factor for stroke, heart disease, kidney disease, and retinopathy is high blood pressure. Lifestyle modification has been emphasised in recent guidelines for the prevention and treatment of hypertension.

It has been demonstrated that reducing sodium intake, losing weight, and increasing physical activity are lifestyle changes that can lower hypertension.

This includes a diet low in total and saturated fat and high in fruits, vegetables, and low-fat dairy products (Al-wehedy, Abd Elhameed, & Abd El-Hammed, 2015).

Despite the aforementioned reality, numerous studies have shown that the majority of hypertension patients lack sufficient understanding about changing their lifestyle.

About 87.1% of participants in a study on the perception and practice of lifestyle modification in South-East Nigeria were unaware that regular exercise is a component of lifestyle modification, and 60% were unaware that moderate alcohol consumption is recommended.

Eighty percent or more were unaware of the benefits of unsaturated fat and a diet low in fruits, vegetables, and dairy products for blood pressure regulation. Of the 88% who knew something about salt limitation, somewhat more than 60% actually followed it.

The few who are aware of weight loss, consistent exercise, fruit consumption, cigarette smoking, and moderate alcohol use can also benefit from this.

According to the study, the degree of practice was negatively correlated with both diastolic and systolic blood pressure. This illustrates how poorly the participants in the study understood and applied lifestyle changes. (Emmanuel Okwuonu and Ojimadu, 2014).